2015 Quick Guide to Individual and Family Plans

Transcription

1 2015 Quick Guide to Individual and Family Plans We believ e San Di egans deserve the best. Quality, affordable health care coverage is just 3 simple steps away. 1 Select a Provider Network 2 Choose the Right Plan for You 3 Enroll Today! Effective January 1, 2015

2 Choose Sharp Health Plan As the only not-for-profit, commercial health plan based in San Diego, we not only serve the people of San Diego, we are the people of San Diego. We re here to make your health care experience as personal, affordable and convenient as possible. Quality You Can Count On We are recognized among the Top 100 Health Plans in the Nation and rated highest for overall satisfaction and customer service among reporting California health plans. 1 Award-Winning Care You ll receive award-winning care from our nationally recognized doctors, medical groups and hospitals. Local Focus We live, work and play in the same community as our members you will always reach a fellow San Diegan when calling. Health Care, Personalized Everyone deserves a trusted health care partner. From helping you find the right plan to the right doctor, and everything in between, our members consider us their personal health care assistant. We Have the Right Plan for You! $0 $ Preventive Care Rates as Low as $4.04 a Day 2 Guaranteed Coverage 1 Top 100 ranking is based on NCQA s Private Health Insurance Plan Rankings Ratings are based on the 2014 CAHPS results, where Sharp Health Plan (SHP) received an overall summary rating of 86% satisfaction compared to the statewide average of 76%. For customer service, SHP received a 90% satisfaction rating and the statewide average was not reported. The source for data contained in this publication is Quality Compass 2014 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass 2014 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). 2 Rate is valid for an individual age 0-20 in the Premier Network 1 Bronze 4500 HSA plan, effective 1/1/2015. Rate is illustrative, not guaranteed and subject to change.

3 Quality, affordable hea 1 Select a Provider Network Sharp Health Plan offers two provider networks: Performance and Premier. Both networks give you access to award-winning primary care doctors, specialists, hospitals and more. Premier Network (Network 1) A select network of doctors, hospitals and medical groups offering the most value Doctors H 7 Hospitals Sharp Community Medical Group (SCMG)* Sharp Rees-Stealy Medical Group Sharp Chula Vista Medical Center Sharp Coronado Hospital Sharp Grossmont Hospital Sharp Mary Birch Hospital for Women & Newborns Sharp Memorial Hospital Sharp Mesa Vista Hospital Rady Children s Hospital Performance Network (Network 2) A broad network of doctors, hospitals and medical groups offering greater choice and geographical coverage. 1,100+ Doctors H 12 Hospitals Sharp Community Medical Group (SCMG) SCMG Arch Health Partners SCMG Graybill SCMG Inland North Sharp Rees-Stealy Medical Group Rady Children s Health Network/ CPMG Sharp Chula Vista Medical Center Sharp Coronado Hospital Sharp Grossmont Hospital Sharp Mary Birch Hospital for Women & Newborns Sharp Memorial Hospital Sharp Mesa Vista Hospital Fallbrook Hospital Palomar Health Downtown Palomar Medical Center Pomerado Hospital Rady Children s Hospital Tri-City Medical Center Find a doctor at sharphealthplan.com. * Excludes SCMG Arch Health Partners, Graybill and Inland North.

4 lth care coverage is just 3 2 Choose the Right Plan for You Whether you prefer a plan with lower copays or lower monthly premiums, or you just need coverage in case of an emergency, we have a plan that s right for you. Premier Plans (Network 1) Platinum Gold Silver Bronze HSA Medical Expenses Paid by Plan 90% 80% 70% 60% Annual Deductible: $0 $0 $2,000/ $4,000 $4,500/ $9,000 Out-of-Pocket Limit: $4,000/ $8,000 Primary Care/Specialist Visit $20/$40 $30/$50 $45/$65 40%/40% Preventive Care Visit $0 $0 $0 $0 Urgent Care Visit $40 $60 $90 40% ER Visit $150 $250 $250 40% Hospital Stay (up to five days) $250/day $600/day 20% 40% Prescription Drugs (up to 30-day supply) Generic Formulary/Brand Formulary/ Non-Formulary/Specialty Medications $5/$15/ $25/10% * 40%/40%/ 40%/40% Performance Plans (Network 2) Platinum Gold Silver Bronze Medical Expenses Paid by Plan 90% 80% 70% 60% Annual Deductible: $0 $0 $2,000/ $4,000 $5,000/ $10,000 Out-of-Pocket Limit: $4,000/ $8,000 Primary Care/Specialist Visit $20/$40 $30/$50 $45/$65 $60 /$70 Preventive Care Visit $0 $0 $0 $0 Urgent Care Visit $40 $60 $90 $120 ER Visit $150 $250 $250 $300 Hospital Stay 10% 20% 20% 30% Prescription Drugs (up to 30-day supply) Generic Formulary/Brand Formulary/ Non-Formulary/Specialty Medications $5/$15/ $25/10% * $75/30% Depending on your income level and family size, you may be eligible for financial assistance under the Affordable Care Act (ACA) to help pay for your premium and to subsidize your out-of-pocket costs. Deductible applies. * A $250 prescription deductible applies to all prescriptions except generic. Health Savings Account compatible plan. Deductible waived for first three non-preventive office or urgent care visits.

5 simple steps away. 3 Enroll Today! Make life better. Choose Sharp Health Plan. Getting great health care coverage has never been easier. Visit us online or call today to learn more about our plans and benefits. Visit sharphealthplan.com and click Shop and Compare. Call our Customer Care team at (858) or out of 4-star quality rating Depending on your income level and family size, you may be eligible for financial assistance under the Affordable Care Act (ACA) to help pay for your health coverage. To find out if you are eligible, please visit coveredca.com. Visit sharphealthplan.com and click Shop and Compare to view our price guide and get a quote.

6 Extra, Extra, Extra! We know that excellent health care is not enough; it must also be easy to access. The convenience of Sharp Health Plan extends beyond Greater San Diego and beyond standard business hours. The following benefits are available to Sharp Health Plan members at no additional cost: Best Health is one of only eight health plan wellness programs to be accredited nationally. The program provides Sharp Health Plan members with a variety of resources from meal plans to exercise routines to one-on-one personalized health coaching. Sharp Nurse Connection We offer after-hours nurse advice telephone service for Sharp Health Plan members. When you have a health question or concern after regular business hours, a single phone call puts you in touch with a registered nurse. As the walk-in medical clinic located inside select CVS/pharmacy stores, MinuteClinic provides convenient access to basic care, without an appointment. Assist America connects Sharp Health Plan members to doctors, hospitals, pharmacies and other services when faced with a medical emergency while traveling 100 miles or more away from home, or out of the country. Consider us your personal health care assistant! SHPA SHC We re here to help. Customer Care: (858) or customer.service@sharp.com Fax: (858) sharphealthplan.com Like us on Facebook facebook.com/sharphealthplan